Several tissues are involved in temporomandibular joint (TMJ) health, including synovial fluid, the TMJ disc, articular cartilage, and subchondral bone. This article focuses upon bone resorption in temporomandibular joint disorders (TMD) and has the following objectives: (1) to provide a brief review of the current understanding of bone formation and bone resorption (bone remodeling); (2) to present selected case studies which illustrate the spectrum of bone resorption patterns in TMD patients of various ages; (3) to review previous reports in the literature describing loss of subchondral bone in TMD, and (4) to discuss the interaction between osteoporosis and TMD and the potential role for antiresorbing agents in TMD therapy.

Keywords:
Bone resorption, Antiresorbing agents, Temporomandibular joint, Temporomandibular joint disease, Osteoporosis, Osteoclast
1.
Abbott, L., J. Nadler, R.K. Rude (1994) Magnesium deficiency in alcoholism: Possible contribution to osteoporosis and cardiovascular disease in alcoholics. Alcoholism Clin Exp Res 18:1076–1082.
2.
Arnett, G.W., S.B. Milam, L. Gottesman (1996) Progressive mandibular retrusion – Idiopathic condylar resorption. Part I. Am J Orthod Dentofacial Orthop 110: 8–15.
3.
Avioli, L.V. (1993) Hormonal alterations and osteoporotic syndromes. J Bone Miner Res 8(suppl 2): S511–S514.
4.
Bean, L.R., K.-Ä.Ö.T. Omnell (1977) Comparison between radiologic observations and macroscopic tissue changes in temporomandibular joints. Dentomaxillofac Radiol 6: 90–106.
5.
Boering, G. (1994) Temporomandibular Joint Osteoarthrosis. A Clinical and Radiographic Investigation; thesis University of Groningen.
6.
Bunker, V.W. (1994) The role of nutrition in osteoporosis. Br J Biomed Sci 51: 228–240.
7.
Chesnut, C.H., 3rd (1991) Theoretical overview: Bone development, peak bone mass, bone loss, and fracture risk. Am J Med 91: 2S–4S.
8.
de Bont, L.G., L.C. Dijkgraaf, B. Stegena (1997) Epidemiology and natural progression of articular temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 83:72–76.
9.
Dijkgraaf, L.C., R.S. Liem, L.G. de Bont (1997) Synovial membrane involvement in osteoarthritic temporomandibular joints: A light microscopic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 83: 373–386.
10.
Dijkgraaf, L.C., R.S. Liem, L.T. van der Weele, L.B. de Bont (1999) Correlation between arthroscopically observed changes in synovial light microscopic findings in osteoarthritic temporomandibular joints. Int J Oral Maxillofac Surg 28: 83–89.
11.
Ducy, P., T. Schinke, G. Karsenty (2000) The osteoblast: A sophisticated fibroblast under central surveillance. Science 289: 1501–1504.
12.
Ebeling, P.R. (1998) Osteoporosis in men. New insights into aetiology, pathogenesis, prevention, and management. Drugs Aging 13:421–434.
13.
Eisman, J.A. (1999) Genetics of osteoporosis. Endocr Rev 20: 788–804.
14.
Flygare, L., H. Hosoki, A. Petersson, M. Rohlin, S. Akerman (1997) Bone volume in human temporomandibular autopsy joints with and without erosive changes. Acta Odontol Scand 55:167–172.
15.
Flygare, L., M. Rohlin, S. Åkerman (2002) Microscopy and tomography of erosive changes in the temporomandibular joint. An autopsy study. Acta Odontol Scand 53: 297–303.
16.
Gennari, C., G. Martini, R. Nuti (1998) Secondary osteoporosis. Aging Clin Exp Res 10: 214–224.
17.
Gruber, H.E., D.J. Baylink (1981) The diagnosis of osteoporosis. J Am Geriatr Soc 29: 490–497.
18.
Gruber, H.E., J.L. Ivey, E.R. Thompson, C.H.I. Chesnut, D.J. Baylink (1986) Osteoblast and osteoclast cell number and cell activity in postmenopausal osteoporosis. Miner Electrolyte Metab 12: 246–254.
19.
Hansson, T., T. Öberg (1977) Arthrosis and deviation in form in the temporomandibular joint. Acta Odontol Scand 35: 167–174.
20.
Heaney, R.P. (1998) Pathophysiology of osteoporosis. Endocrinol Metab Clin North Am 27: 255–265.
21.
Hofbauer, L.C., F. Gori, B.L. Riggs, D.L. Lacey, C.R. Dunstan, T.C. Spelsberg, S. Khosla (1999) Stimulation of osteoprotegerin ligand and inhibition of osteoprotegerin production by glucocorticoids in human osteoblastic lineage cells: Potential paracrine mechanisms of glucocorticoid-induced osteoporosis. Endocrinology 140:4382–4389.
22.
Jilka, R.L., G. Hangoc, G. Firasole, G. Passeri, D.C. Williams, J.S. Abrams, B. Boyce, H. Broxmeyer, S.C. Manolagas (1992) Increased osteoclast development after estrogen loss: Mediation by interleukin-6. Science 257: 88–91.
23.
Johnston, C.C., Jr., C.W. Slemenda (1995) Pathogenesis of osteoporosis. Bone 17(suppl): 19S–22S.
24.
Khosla, S. (2002) Minireview: The OPG/RANKL/RANK system. Endocrinology 142: 5050–5055.
25.
Kirk, W.S., Jr. (2002) Risk factors and initial surgical failures of TMJ arthrotomy and arthroplasty: A four to nine year evaluation of 303 surgical procedures. J Craniomandibular Pract 16:154–161.
26.
Malinin, T., E.A. Ouellette (2000) Articular cartilage nutrition is mediated by subchondral bone: A long-term autograft study in baboons. Osteoarthritis Cartilage 8: 483–491.
27.
Manelli, F., A. Giustina (2000) Glucocorticoid-induced osteoporosis. TEM 11: 79–85.
28.
Manolagas, S.C., T. Bellido, R.L. Jilka (1995) New insights into the cellular, biochemical, and molecular basis of postmenopausal and senile osteoporosis: Roles of IL-6 and gp130. Int J Immunopharmacol 17: 109–116.
29.
Manolagas, S.C., R.L. Jilka (1995) Bone marrow, cytokines, and bone remodeling. Emerging insights into the pathophysiology of osteoporosis. N Engl J Med 332: 305–311.
30.
Marcus, R., M. Wong, H. Heath 3rd, J.L. Stock (2002) Antiresorptive treatment of postmenopausal osteoporosis: Comparison of study designs and outcomes in large clinical trials with fracture as an endpoint. Endocr Rev 23: 16–37.
31.
Milam, S.B., R.J. Klebe, R.G. Triplett, D. Herbert (1991) Characterization of the extracellular matrix of the primate temporomandibular joint. J Oral Maxillofac Surg 49: 381–391.
32.
Milam, S.B., G. Zardeneta, J.P. Schmitz (1998) Oxidative stress and degenerative temporomandibular joint disease: A proposed hypothesis. J Oral Maxillofac Surg 56: 214–223.
33.
Mosekilde, L. (1992) Osteoporosis and calcium. J Intern Med 231: 145–149.
34.
Moses, O., C.E. Nemcovsky, H. Tal, R. Zohar (2001) Tetracycline modulates collagen membrane degradation in vitro. J Periodontol 72: 1588–1593.
35.
Nordahl, S., P. Alstergren, A. Appelgran, B. Appelgren, S. Eliasson, S. Kopp (1997) Pain, tenderness, mandibular mobility, and anterior open bite in relation to radiographic erosions in temporomandibular joint disease. Acta Odontol Scand 55: 18–22.
36.
Öberg, T., C.E. Carlsson, C.M. Fajers (1971) The temporomandibular joint. A morphologic study on a human autopsy material. Acta Odontol Scand 29: 349–384.
37.
Pedersen, T.K., J.J. Jensen, B. Melsen, T. Herlin (2001) Resorption of the temporomandibular condylar bone according to subtypes of juvenile chronic arthritis. J Rheumatol 28: 2109–2115.
38.
Puzas, J.E., J.-M. Landeau, R. Tallents, J. Albright, E.M. Schwartz, R. Landesberg (2001) Degradative pathways in tissues of the temporomandibular joint. Cells Tissues Organs 169: 248–256.
39.
Roodman, G.D. (1996) Advances in bone biology: The osteoclast. Endocr Rev 17: 308–332.
40.
Ryan, M.E., A. Usman, N.S. Ramamurthy, L.M. Golub, R.A. Greenwald (2001) Excessive matrix metalloproteinase activity in diabetes: Inhibition by tetracycline analogues with zinc reactivity. Curr Med Chem 8: 305–316.
41.
Smith, J.A., N.A. Sandler, W.H. Ozaki, T.W. Braun (1999) Subjective and objective assessment of the temporalis myofascial flap in previously operated temporomandibular joints. J Oral Maxillofac Surg 57: 1058–1065.
42.
Tanguay, D., R.D. Schwarz, C.S. Greene, D.P. Forbes, H.T. Perry, P. Lakatos, P.H. Stern (1993) Temporomandibular joint synovial fluid effect on resorption of mouse calvarial bone in vitro. Northwestern Dent Res 4: 11–16.
43.
Teitelbaum, S.L. (2000) Bone resorption by osteoclasts. Science 289: 1504–1508.
44.
Teti, A., P.C. Marchisio, A.Z. Zallone (1991) Clear zone in osteoclast function: Role of podosomes in regulation of bone-resorbing activity. Am J Physiol 261: C1–C7.
45.
Udagawa, N., N. Takashashi, T. Akatsu, H. Tanaka, T. Sasaki, T. Nishihara, T. Koga, T.J. Martin, T. Suda (1990) Origin of osteoclasts: Mature monocytes and macrophages are capable of differentiating into osteoclasts under a suitable microenvironment prepared by bone marrow-derived stromal cells. Proc Natl Acad Sci USA 87: 7260–7264.
46.
Väänäen, H.K., M. Horton (1995) The osteoclast clear zone is a specialized cell-extracellular matrix adhesion structure. J Cell Sci 108: 2729–2732.
47.
Wolford, L.M., L. Cardenas (2002) Idiopathic condylar resorption: Diagnosis, treatment protocol, and outcomes. Am J Orthod Dentofacial Orthop 116: 667–677.
48.
Yasuoka, T., M. Nakashima, T. Okuda, N. Tatematsu (2000) Effect of estrogen replacement on temporomandibular joint remodeling in ovariectomized rats. J Oral Maxillofac Surg 58: 189–196.
© 2003 S. Karger AG, Basel
2003
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.